Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 21, 2014 PDF

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If your nurse practitioner is trying to order and refer Medicare services, he’d better have a master’s degree, or your enrollment process will be filled with headaches. That’s the word from a Feb. 19 Medicare Open Door Forum.

An office manager called into the session to say that when trying to enroll her nurse practitioner (NP) into Medicare’s PECOS system solely for the purpose of ordering and referring, she was unable to do so. Upon calling Medicare, she learned that CMS will not allow NPs to enroll without a master’s degree and certification. The caller stressed that her practice’s NPs are appropriately licensed, but because they don’t bill Medicare, they are stuck in the gray area between licensure and enrollment.

“We now require a master’s degree to enroll in Medicare as a nurse practitioner,” said CMS’s William Rogers, MD, in response to the question. Even though these NPs have been licensed for over 20 years and were grandfathered into Medicare when the master’s degree rules went into effect in 2000, the new ordering/referring regulations throw a wrinkle into it since the NPs didn’t enroll in Medicare prior to 2000.

Although CMS reps did not have an immediate solution to the problem, it’s something you should look out for if you’re in a similar situation. Keep an eye on the Insider for more on this as CMS attempts to resolve the issue.